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RA1 22.C1  N48  1914    A  brief  account  of  p 


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PROGRESS 


OF  THE 


DEPARTMENT  OF  HEALTH 


During  the  Year  1914 


DEPARTMENT    OF    HEALTH 

OF  THE  CITY  OF  NEW  YORK 
139  CENTRE  STREET 


A  BRIEF  ACCOUNT  OF  PROGRESS 


MADE  BY  THE 


DEPARTMENT  OF  HEALTH 


OF  THE 


CITY   OF   NEW   YORK 


IN 


THE  YEAR  1914 


507,  '15,  15,000  (P) 


A  BRIEF  ACCOUNT  OF  PROGRESS 

MADE  BY  THE 

DEPARTMENT  OF  HEALTH 

THE  YEAR  1914 


Number  of  Persons  Employed 

On  January  1st,  1914,  there  were  connected  with  the  Department 
in  an  official  capacity  3,428  persons;  of  this  number,  79,  all  physicians, 
gave  gratuitous  service  in  hospitals  or  clinics.  The  corresponding 
figures  for  January  1st,  1915,  are:  Total  number  of  persons  employed 
in  the  Department,  3,421,  of  which  95  are  unpaid. 

The  Year's  Expenditures  and  Savings 

The  total  sum  appropriated  for  the  current  expenses  of  the 
Department  of  Health  for  the  year  1914  was  $3,534,240.50.  Of  this 
sum  $3,363,767.85  was  expended  by  the  Department,  leaving  a  balance 
of  $170,472.65,  largely  the  result  of  careful  economies  in  administra- 
tion. The  sum  of  $17,178.50  was  transferred  to  other  departments  to 
cover  deficiencies.  There  remained  at  the  end  of  the  year  an  unex- 
pended balance   of  $153,294.15. 

It  is  evident  from  the  above  figures  that  the  Department  is  one 
of  considerable  magnitude.  Its  importance  to  the  community  is 
shown  by  the  following  account  of  its  progress  during  the  year  1914. 
Before  passing  to  this  account,  however,  it  may  be  well  to  consider 
what  the  law  demands  of  the  Board  of  Health. 

Duties  of  the  Board  of  Health 

The  following  extracts  from  the  Greater  New  York  Charter  show 
the  extent  of  the  responsibility  with  which  the  Board  of  Health  is 
charged  by  law: 

It  shall  be  the  duty  of  the  Board  of  Health  to  aid  in  the  enforce- 
ment of,  and,  so  far  as  practicable,  to  enforce  all  laws  of  this  state, 
applicable  in  said  district  (i.  e.,  the  city  and  the  waters  adjacent  there- 
to), to  the  preservation  of  human  life,  or  to  the  care,  promotion,  or 
protection  of  health;  and  said  Board  may  exercise  the  authority  given 
by  said  laws  to  enable  it  to  discharge  the  duty  hereby  imposed;  this 
section  is  intended  to  include  all  laws  relative  to  cleanliness,  and  to 


the  use  or  sale  of  poisonous,  unwholesome,  deleterious,  or  adulterated 
drugs,  medicines  or  food,  and  the  necessary  sanitary  supervision  of 
the  purity  and  wholesomeness  of  the  water  supply  for  the  City  of  New 
York.  • 

The  Board  is  authorized  to  require  reports  and  information  relative 
to  the  safety  of  life  and  promotion  of  health,  from  all  public  dispen- 
saries, hospitals,  asylums,  infirmaries,  prisons  and  schools,  and  from  all 
other  public  institutions,  and  from  the  managers  and  occupants  of  all 
theatres  and  other  places  of  public  resort  or  amusement. 

The  Board  shall  use  all  reasonable  means  for  ascertaining  the  exist- 
ence and  cause  of  disease  or  peril  to  life  or  health,  and  for  averting  the 
same. 

It  shall  be  the  duty  of  said  Board  to  gather  and  preserve  such 
information  and  facts,  relating  to  death,  disease  and  health,  from  other 
parts  of  this  state,  but  especially  in  said  city,  as  may  be  useful  in  the 
discharge  of  its  duties,  and  contribute  to  the  promotion  of  health,  or 
the  security  of  life  in  the  State  of  New  York. 

The  sanitary  code,  which  shall  be  in  force  in  the  City  of  New  York 
the  first  day  of  January,  nineteen  hundred  and  two,  to  be  binding  and 
in  force,  is  hereby  declared  and  shall  continue  to  be  so  binding  and  in 
force,  except  as  the  same  may,  from  time  to  time,  be  revised,  altered, 
amended  or  annulled. 

The  Board  of  Health  is  hereby  authorized  and  empowered,  from 
time  to  time,  to  add  to  and  to  alter,  amend  or  annul  any  part  of  the 
said  sanitary  code,  and  may  therein  publish  additional  provisions  for 
the  security  of  life  and  health  in  the  City  of  New  York,  and  confer 
additional  powers  on  the  Department  of  Health,  not  inconsistent  with 
the  constitution  or  laws  of  this  state,  and  may  provide  for  the  enforce- 
ment of  the  said  sanitary  code  by  such  fines,  penalties,  forfeitures,  or 
imprisonment  as  may  by  ordinance  be  prescribed. 

The  Board  of  Health  may  embrace  in  said  sanitary  code  all  matters 
and  subjects  to  which,  and  so  far  as,  the  power  and  authority  of  said 
Department  of  Health  extends,  not  limiting  their  application  to  the  sub- 
ject of  health  only. 

Is  the  Board  of  Health  doing  all  that  the  law  requires  of  it?  There 
are  many  citizens  who  hold  the  contrary,  and  by  these,  day  by  day,  the 
Department  is  urged  to  widen  the  scope  of  its  activities.  Its  present 
effort  is  to  increase  its  usefulness  without  adding  to  its  expenditures. 
If  it  succeeds  in  this,  the  conservatives  in  finance  and  the  progressives 
in  policy  should  both  be  satisfied. 

The  Health  of  the  City. 

The  number  of  deaths  reported  during  the  year  was  74,803,  mak- 
ing a  rate  of  13.40  per  1,000  of  the  population.  This  is  the  lowest 
death  rate  ever  recorded  in  the  City  of  New  York.  If  we  compare 
this  with  last  year's  record,  namely,  73,902  deaths  and  a  rate  of  13.76 
for  the  year  1913,  we  find  that  there  has  been  a  decrease  in  the  death 
rate  of  .36  of  a  point.  How  much  this  means  to  the  community  may 
perhaps  be  better  appreciated  by  saying  that  if  the  death  rate  of 
1913  had  prevailed  during  the  past  year,  there  would  have  been 
2,010  more   deaths  than  actually  occurred. 

A  Notable  Decrease  in  Infant  Mortality. 

The  most  noteworthy  feature  of  the  decreased  mortality  was 
the  record-breaking  infant  death  rate  of  94.6  per  1,000  children  born. 


This  is  the  lowest  infant  death  rate  ever  attained  in  the  City  of  New 
York,  and  the  lowest  of  any  large  city  in  this  country.  The  infant 
death  rate  in  1913  was  102,  which  was  the  lowest  rate  in  the  City  up 
to  that  year,  so  that  the  decrease  this  year  in  the  rate  over  last  year 
is  a  little  over  6  per  cent.  The  Bureau  of  Child  Hygiene  claims  and 
is  entitled  to  a  measure  of  credit  for  this  splendid  result. 

Analysis  of  Causes  of  Death. 
The  following  causes  of  death  showed  a  considerably  decreased 
mortality:  typhoid  fever,  measles,  scarlet  fever,  all  forms  of  acute 
respiratory  diseases  and  diarrhoeal  diseases  under  five  years  of  age. 
There  were  10,286  deaths  from  all  forms  of  tuberculosis  as  against 
10,031  deaths  in  1913.  The  slight  increase  in  the  absolute  figures, 
however,  is  more  than  accounted  for  by  the  increase  in  population, 
so  that  there  is  actually  a  slight  decrease  in  the  rate  per  1,000  of  the 
population.  There  were  16,804  deaths  from  the  combined  causes  of 
organic  heart,  kidney  and  brain  diseases  as  against  16,194  in  1913, 
an  increase  of  610  deaths.  The  number  of  deaths  from  cancer  was 
4,463,  an  increase  of  240  over  the  figure  of  last  year;  4,516  infants 
died  from  congenital  causes,  such  as  malformations,  marasmus,  pre- 
maturity, etc.;  4,982  people  met  with  violent  deaths;  the  death  rate 
from  purely  accidental  deaths  decreased  somewhat,  whilst  that  from 
suicides  increased  considerably,  there  having  been  915  deaths  reported 
from  this  cause;  13,312  children  died  before  completion  of  the  first 
year  of  life  and  19,518  before  completion  of  the  fifth  year.  There 
were  41,235  deaths  of  males  as  against  33,568  deaths  of  females; 
30,825  deaths  occurred  in  institutions,  29,561  in  tenements,  11,819  in 
dwellings  and  746  persons  in  hotels.  In  addition  to  this  1,852  died 
in  rivers,  streets,  etc. 

Important  Officials  Placed  on  Full-Time  Service. 
From  the  standpoint  of  general  organization  and  departmental 
efficiency,  the  most  important  general  order  issued  during  the  year 
was  that  requiring  full-time  service  on  the  part  of  bureau  chiefs  and 
other  important  Department  officials.  This  order,  which  is  now 
effective,  was  as  follows: 

Directors  of  Bureaus  who  are  in  receipt  of  salaries  of  $5,000.00  or 
more  per  annum,  and  Assistant  Directors  of  Bureaus,  Assistant  Sanitary 
Superintendents.  Chiefs  of  Divisions  and  all  other  medical  officers  who 
are  in  receipt  of  salaries  of  $3,000.00  or  more  per  annum,  are  hereby 
declared  to  be  full-time  officers  of  the  Department  and,  as  such,  are 
required  to  give  their  services  to  the  Department  during  the  full  working 
day. 

They  shall  not  be  allowed  to  engage  in  the  general  practice  of  medi- 
cine, or  in  any  other  regular  occupation  or  business.  With  the  approval 
of  the  Commissioner,  they  may  be  permitted  to  engage  in  public  health 
work  outside  of  the  Department,  but  the  Department  retains  the  right 
to  determine  whether  such  outside  work  interferes  with,  or  is  prejudicial 
to,  the  proper  performance  of  departmental  duty,  and,  after  due  notice, 
may  withdraw  such  permission  at  any  time. 

Public  health  administration   thus  becomes  a  career — though,  it 


8 

must   be   acknowledged,   not   a   particularly    remunerative   one — for  a 
limited  number  of  qualified  men  in  the  City  of  New  York. 

The  Sanitary  Code  Rewritten. 

The  Sanitary  Code  has  been  completely  rewritten,  and  in  its  new 
form  is  definitely  correlated  to  the  ordinances  of  the  Board  of  Alder- 
men. This  was  brought  about  by  conference  with  the  Codification  Com- 
mittee of  the  Board  of  Aldermen.  In  the  preparation  of  the  new  Code, 
the  Board  was  assisted  constantly  and  ably  by  the  Corporation  Counsel 
and  his  staff. 

Among  the  twenty  or  more  sections  which  have  been  added  to 
the  Code,  the  most  important,  from  the  standpoint  of  public  health, 
are  the  following: 

1.  Requiring  the  naming  of  ingredients  of  "patent"  medicines  on  the 

labels  of  the  packages,  or,  in  lieu  thereof,  the  registration 
of  the  ingredients  with  the  Department  of  Health. 

2.  Requiring  employers  to  uss  reasonably  effective  devices,  means 

and  methods  to  prevent  the  contraction  by  employees  of  ill- 
ness or  disease  incident  to  the  work  or  process  in  which  such 
employees  are  engaged. 

3.  Providing  for  the  sanitation,  ventilation  and  lighting  of  theatres  and 

other  places  of  assembly,  and  of  all  places  where  people  are 
employed. 

4.  Requiring   owners  of  stables  to   obtain  permits  from  the  Board  of 

Health,  and  to  conduct  their  establishments  in  accordance  with 
prescribed   regulations. 

5.  Regulating  the  cold  storage  of  food. 

6.  Requiring  physicians,  when  reporting  infectious   diseases,  to   specify 

whether  the  individual  affected  has  been  engaged  in  handling 
food  products. 

7.  Requiring    institutions    and    private    physicians    to    report    cases    of 

venereal  diseases. 

8.  Requiring   superintendents   of  hospitals   and  private  practitioners  to 

report  occupational  diseases  and  injuries. 

9.  Requiring  physicians  and  superintendents  of  hospitals  to  report 

groups  of  cases  of  suspected  food  poisoning. 

10.  Providing,   in   the  interest  of   school    children,    for  the   supervision, 

and  in  case  of  necessity  only,  for  the  exclusion  from  school  of 
teachers  suffering  from  pulmonary  tuberculosis  in  a  communica- 
ble form. 

11.  Prohibiting  persons  who   are  suffering  from  communicable  diseases 

from  working  in  their  homes  upon  articles  intended  for  general 
consumption. 

12.  Prohibiting  the  distribution  of  free  samples  of  proprietary  medicines 

or  other  substances  of  an  alleged  medicinal  or  curative  character 
intended  for  internal  human  use. 


13.  Regulating    the    free    distribution    of    vaccine,    antitoxin,    serum   and 

cultures,  and  providing  a  penalty  for  physicians  who  accept  pay- 
ment for  vaccines  and  analogous  products  which  have  been  ob- 
tained from  the  Department  gratuitously. 

14.  Providing  that  persons  ill  with  communicable  disease  may  not 

handle  or  sell  food. 

15.  Providing   for   decent  and   clean  conditions  in  food  manufactories, 

hotel  and  restaurant  kitchens  and  retail  food  stores. 

16.  Providing  for  the  physical  examination  of  children  at  the  time  of 

entering  public  school  by  private  physicians  or  by  medical  in- 
spectors of  the  Department  of  Health.  (This  section  corre- 
sponds in  substance  with  a  statute  which  applies  to  all  parts 
of  the  state  except  the  City  of  New  York.) 

17.  Providing  for  the  control  by  permit  of  all  private  hospitals  other 

than  those  which  are  specifically  authorized  by  law. 

18.  Requiring  the  lessees  or  owners  of  marsh  lands  and  sunken  lots  to  fill 

in  or  drain  the  same  or  to  employ  such  other  methods  as  will 
prevent  the  breeding  of  mosquitoes. 

19.  Providing  for  the  sanitation  of  passenger  cars  and  omnibuses. 

20.  Regulating  public  laundries. 

21.  Prohibiting    offensive    and    dangerous    practices    in   the   manufacture 

of  cigars  and  cigarettes. 

22.  Requiring  the  ■  removal  of  harmful  dust,  gases  and  other  impurities 

from  work  rooms  by  suction  devices. 
In  addition  to  the  introduction  of  this  important  new  matter,  the 
Code  has  been  changed  in  form  so  that  its  contents  are  now  more 
logically  arranged.  From  beginning  to  end  the  language  has  been  sim- 
plified, and  wherever  necessary  has  been  changed  so  as  to  harmonize 
with  existing  statutes,  with  aldermanic  ordinances,  and  with  the  regu- 
lations of  other  departments. 

Code  Amendments  Adopted  Prior  to  the  General  Revision. 

During  the  year,  prior  to  the  general  revision  of  the  Code,  the  fol- 
lowing important  amendments  were  adopted : 

1.  Prohibiting  the  sale  of  bichloride  of  mercury  except  upon  a 
physician's  prescription. 

2.  Prohibiting  unmuzzled  dogs  in  streets  and  other  public  places. 

3.  Prohibiting  the  use  of  wood  alcohol  in  preparations  intended 
for  human  use. 

4.  Prohibiting  the  sale  of  opium,  morphine,  and  other  habit-forming 
drugs  except  on  the  written  prescription  of  a  physician. 

5.  Requiring  the  manufacturers  and  importers  of  artificial  or  natural 
spring  water  to  file  with  the  Department  certain  information  concerning 
the  character  and  composition  of  the  water. 

6.  Prescribing  the  duties  of  physicians,  hospitals,  dispensaries,  and 
other  institutions  with  respect  to  reportable  diseases. 

7.  Prohibiting  the  common  use  of  forks  at  free  lunch  counters. 


10 

New  Sanitary  Regulations. 

Among  the  important  regulations  promulgated  by  the  Department 
during  the  year  are  the  following : 

1.  Regulations  providing  for  sanitary  conditions  in  floating  baths, 
stationary  pools,  and  bathing  beaches. 

2.  Regulations  governing  sanitary  conditions  of  tents,  camps  and 
bungalows. 

3.  Regulations  regarding  the  use  of  coffin  seals  in  cases  of  death 
from  infectious   diseases. 

4.  Regulations  regarding  the  sale  of  milk  and  cream,  including 
sections  relating  to  bacterial  content. 

5.  Regulations  safeguarding  the  health  of  children  cared  for  in 
day  nurseries. 

6.  Regulations  governing  the  handling,  storing  and  sale  of  food  in 
stores,  factories,  hotels,  restaurants,  etc. 

The  New  Bureau  of  Public  Health  Education. 

There  was  established  during  the  year  a  bureau  known  as  the  Bureau 
of  Public  Health  Education.  The  working  staff  of  this  Bureau  was  re- 
cruited within  the  Department  by  the  transfer  of  workers  of  special  talent 
as  writers,  compilers  and  lecturers,  from  existing  branches  of  the  service. 
Its  creation,  therefore,  committed  the  city  to  no  new  expense.  The  func- 
tions of  the  Bureau  of  Public  Health  Education  as  thus  far  developed 
may  be  briefly  described  as  follows : 

Publications:  Preparation  and  issuance  of  press  bulletins,  of  a 
weekly  bulletin  sent  to  all  physicians,  school  principals,  clergymen,  city 
officials,  etc.,  of  a  monthly  bulletin  containing  special  articles  on  public 
health  subjects,  staff  news  for  the  information  of  employees  of  the 
Department  of  Health,  the  Otisville  Ray  for  the  information  of  the 
patients  at  the  Municipal  Sanatorium,  reprints  and  monographs  descriptive 
of  the  Departmental  activities,  circulars  of  information,  placards,  etc. 

Lectures:  Organization  and  giving  of  educational  lectures  on  health 
topics  for  employees  of  the  Department  of  Health  and  for  high  schools, 
colleges,  clubs,  civic  organizations,  labor  unions,  etc. 

Exhibits:  The  preparation  and  display  of  exhibits  dealing  with  the 
work  of  the  Department.  Such  exhibits  shown  in  schools,  settlement 
houses,  clinics,  vacant  stores,  etc. 

Moving  Picture  Activities:  The  preparation  and  exhibition  of  films 
devoted  to  public  health  topics,  the  holding  of  free  moving  picture  exhi- 
bitions in  parks,  recreation  centers,  play-grounds,  etc.  Co-operating  with 
moving  picture  theatres  to  display  lantern  slides  dealing  with  matters 
of  public  health. 

Co-operating  with  other  city  departments  and  organizations  inter- 
ested in  public  health  work  and  providing  these  with  material  suitable  for 
educating  the  public  in  health  matters. 


11 

Lectures  for  Department  Employees. 

A  comprehensive  course  of  lectures  has  been  developed  under 
the  direction  of  the  Bureau  of  Public  Health  Education.  These 
lectures,  designed  to  better  fit  the  employees  of  the  Department  for 
their  work,  are  now  in  full  swing.  The  courses  include  lectures  for 
the  different  groups  of  Department  employees  as  follows:  Medical 
Inspectors,  Sanitary  and  Food  Inspectors,  Hospital  Nurses,  Field 
Nurses,  Clerks. 

Physical  Examination  of  Department  Employees. 

In  order  to  safeguard  and  improve  the  health  of  the  employees 
of  the  Department,  the  Department  has  undertaken  to  make  a  thor- 
ough physical  examination  of  all  its  employees.  Originally  regarded 
with  suspicion,  these  examinations  are  now  eagerly  sought  by  all 
classes  of  employees.  During  the  year  1,237  persons,  437  men  and 
800  women,  were  examined.  The  results  have  been  invaluable;  cases 
of  unsuspected  disease  have  been  discovered,  and  treatment  and  pre- 
ventive measures  have  been  inaugurated.  Cases  of  absence  on  ac- 
count of  illness  are  investigated,  emergency  treatment  to  employees 
taken  ill  while  on  duty  is  administered  and  constant  supervision  is 
exercised  over  the  health  of  the  employees.  The  adoption  of  the 
plan  in  all  municipal  departments  is  urged. 

Other  Welfare  Activities. 

The  Department  has  completed  arrangements  for  the  establishment 
of  a  lunch  room  where  the  employees  of  the  Department  will  be  fur- 
nished wholesome  and  well-cooked  food  at  reasonable  prices. 

The  roof  of  the  Department's  building  is  now  utilized  for  recrea- 
tion during  the  noon  hour. 

The  Department  Becomes  Interested  in  Industrial  Hygiene. 

Throughout  this  report  evidence  is  presented  of  the  increasing 
emphasis  which  the  Department  places  on  education  in  matters  of 
sanitation  and  hygiene  as  the  principal  means  for  the  accomplishment 
of  its  ends. 

An  important  new  education  activity  is  the  work  which  the  Depart- 
ment has  begun  in  relation  to  industrial  hygiene.  Education  in  matters 
of  industrial  hygiene  has  hitherto  been  left  entirely  to  private  effort. 
From  time  to  time,  legislation  to  promote  occupational  hygiene  has  been 
prompted  by  private  societies.  This  year  the  Department  of  Health  of 
the  City  of  New  York,  for  the  first  time  ''n  its  history,  has  claimed 
this  field  for  its  own.  The  method  proposed,  however,  is  wholly  that 
of  education.  No  increase  in  the  Department's  force  of  inspectors  is 
contemplated. 

Wherever  the  rate  of  sickness  is  unduly  high  because  of  insanitary 
conditions  of  employment,  there  the  Department  is  ready  to  enter.  In 
the  first  instance,  it  asks  for  the  support  of  the  individuals  affected  by 
existing    sanitary   conditions,    making   its   appeal   both   to    employees   and 


12 

employers.  In  a  bulletin  which,  on  November  14th,  was  addressed  to 
numerous  trade  unions,  the  Department  announced  its  readiness  "to 
undertake  a  sanitary  survey  of  any  industry,  trade  or  group  of  manufac- 
turing establishments  in  the  city,  with  a  view  to  appraising  existing  con- 
ditions, and  in  order  to  show  to  employees  and  employers  alike  what 
can  be  accomplished  through  a  system  of  voluntary  hygienic  and  sani- 
tary control."  Responses  have  been  received  from  a  number  of  trades 
and  plans  are  now  afoot  which  will  result  in  the  formulation  of  sanitary 
industrial  standards  and  in  measures  for  the  prevention  of  industrial 
diseases. 

Periodic  Medical  Inspection  of  Workers. 

The  Department  advocates  the  development  of  a  system  of  periodic 
medical  inspection  of  workers  in  large  establishments,  similar  to  the 
system  of  medical  inspection  of  school  children,  which  is  now  universally 
recognized  as  an  indispensable  part  of  an  effective  public  health  program. 
Employers  and  workers  are  urged  to  co-operate  with  the  Department  in 
the  establishment  of  medical  inspection  systems  in  industries  in  which 
such  inspection  is  especially  important  from  the  standpoint  of  communi- 
cable disease. 

Food   Inspection   Reorganized. 

The  Bureau  of  Food  Inspection  has  been  completely  reorganized. 
It  is  preparing  to  undertake  the  systematic  inspection  of  all  classes  of 
establishments  in  this  city  (except  those  under  Federal  or  State  inspec- 
tion) where  food  is  manufactured,  prepared  or  sold.  The  effectiveness 
of  the  work  of  the  Bureau  has  been  increased  by  the  adoption  of  a  plan 
for  the  district  assignment  of  inspectors;  duplication  and  overlapping 
have  thus  been  avoided. 

Additional  Inspectors  of  Food. 

The  Department  confidently  predicts  that  1915  will  be  a  notable 
year  in  its  food  inspection  work  in  consequence  of  enhanced  depart- 
mental and  public  interest  in  this  work,  and  in  view  of  the  appropriation 
granted  in  this  year's  budget  for  the  extension  of  food  work. 

All  Milk  Effectively  Pasteurized. 

The  protection  of  the  city  through  the  pasteurization  of  the  bulk  of 
its  milk  supply  is  now  an  accomplished  fact.  No  raw  milk  is  allowed 
to  be  sold  except  that  which  is  obtained  from  tuberculin-tested  cows. 

"Certified  Milk"  Supervised  by  the  Department  of  Health. 

Prior  to  1914  the  Department  systematically  avoided  the  inspection 
of  dairy  farms  which  were  conducted  under  the  auspices  of  the  Milk 
Commissions  of  the  various  County  Medical  Societies.  After  due  con- 
sideration it  wras  decided  that,  in  view  of  the  fact  that  the  Department 
is  responsible  to  the  city  for  the  safety  of  the  entire  milk  supply,  the 
dairy  farms  of  the  Milk  Commissions  were  logically  subject  to  the  sys- 
tem of  examination  and  inspection  which  is  carried  on  by  the  Depart- 
ment elsewhere.     It  was  ordered  that  these  dairies  should  be   inspected 


13 

and  their  products  examined  periodically,  that  careful  records  should  be 
kept,  and  that  suitable  permits  should  be  issued.  This  action  has  met 
with  the  approval  of  the  Milk  Commissions,  whose  voluntary  activities 
have  not  been  diminished,  and  which  continue  to  "certify"  milk  which 
conforms  to  their  own  high  standard. 

Conferences  of  Food  Inspectors. 

In  view  of  the  many  new  activities  of  the  Bureau  of  Food  Inspection, 
and  in  order  to  insure  uniformity  of  action  by  the  various  inspectors  of 
the  Bureau,  arrangements  were  made  for  bi-weekly  conferences  of 
inspectors,  at  which  the  rules  and  regulations  of  the  Department  and 
their  interpretation  and  application  are  discussed. 

Veterinarians  to  Inspect  Cattle  for  Slaughter. 

Laymen  who  had  been  employed  for  some  time  in  the  inspection 
of  cattle  at  the  Brooklyn  slaughter  houses  were  replaced  by  veterinarians, 
with  resulting  improvement  in  the  service. 

Advisory  Council  Formed. 

Early  in  the  year  an  Advisory  Council  was  organized,  consisting  of 
representatives  of  the  various  trades  that  regularly  come  under  the 
supervision  of  the  Department,  and  including  in  its  membership  as  well 
persons  identified  in  some  way  with  public  health  administration,  and 
those  connected  with  institutions  and  private  societies  whose  objects  are 
akin  to  those  of  the  Department  of  Health. 

The  Advisory  Council  is  divided  into  committees  corresponding  to 
the  several  bureaus  of  the  Department.  It  has  rendered  valuable  assist- 
ance to  the  Department  throughout  the  year  in  the  critical  study  of 
established  procedures  and  in  the  consideration  of  proposed  new  measures. 
Its  most  important  services  were  performed  in  connection  with  the  revi- 
sion of  the  Sanitary  Code.  The  devotion  of  the  members  of  this  volun- 
tary body  to  the  tasks  assigned  to  them  merits  the  thanks  of  the 
Department  and  of  the  city. 

The  Weekly  Bulletin  Sent  to  All  Physicians. 

The  circulation  of  the  Weekly  Bulletin  of  the  Department  has  been 
increased  from  two  thousand  to  twelve  thousand  copies,  making  it  pos- 
sible to  send  it  regularly  to  every  practising  physician  in  the  City  of 
New  York,  and  to  all  institutions  with  which  the  Department  has  offi- 
cial relations.  The  physicians  and  institutions  have  responded  by  a 
more  willing  co-operation  due,  as  one  of  them  wrote,  to  their  better 
understanding  of  "what  the  Department  is  doing  and  why  it  is  doing 
it."  ;  'HI 

Filing  Birth  Certificates. 

An  active  campaign  has  been  carried  on  against  physicians  and  mid- 
wives  for  failure  to  file  certificates  of  birth.  A  special  investigation  in 
the  entire  city  and  covering  several  thousand  babies  selected  at  random 
showed  that  over  98  per  cent,  of  all  births  had  been  reported  according 
to  law. 


-  14 

Central  List  of  Delinquent  Physicians. 

A  central  delinquent  list  has  been  established  of  physicians  who  have 
failed  to  comply  with  regulations  of  the  Department  of  Health.  The 
Department  regrets  the  necessity  for  this  list,  and  hopes  to  see  it  reduced 
to  a  minimum  this  year  and  ultimately  to  be  abolished. 

Infants'  Milk  Stations. 

In  addition  to  the  fifty-six  infants'  milk  stations  maintained  by  the 
Department  of  Health  throughout  the  year,  private  philanthropists  do- 
nated the  rent  and  equipment  of  seven  stations,  for  which  the  Bureau  of 
Child  Hygiene  provided  doctors  and  nurses.  Of  these  seven  stations, 
one  is  in  the  Bronx,  one  in  Brooklyn,  and  five  in  the  hitherto  neglected 
Borough  of  Queens.  Two  new  Department  stations  have  been  authorized 
fPr   1915. 

The  Breast  Feeding  of  Infants. 

It  is  gratifying  to  report  that  there  was  a  marked  increase  in  the 
number  of  breast-fed  babies  in  attendance  at  the  milk  stations,  namely, 
63  per  cent,  in  1914  as  compared  to  55  per  cent,  in  1913. 

Success  of  Prenatal  Work. 

The  experimental  prenatal  work  carried  on  by  the  Bureau  of  Child 
Hygiene  reached  500  mothers,  among  whom  there  were  no  maternal 
deaths.  Ninety-six  per  cent,  of  the  babies  born  are  still  living.  The 
deaths  under  one  month  per  thousand  births  were  16,  as  compared  with 
37  for  the  city  as  a  whole. 

Baby  Week. 

Traditional  methods  of  appeal  in  order  to  arouse  interest  in  infant 
mortality  having  become  outworn,  New  York  determined  to  advertise 
for  her  babies.  A  Baby  Week  was  organized  which  applied  all  the 
approved  and  up-to-date  methods  of  advertising  to  the  business  of 
spreading  abroad  throughout  the  city  what  was  done  and  what  was 
needed  to  be  done  to  save  babies.  Newspapers,  bill  boards,  car  adver- 
tisements, window  posters,  movies,  baby  parades,  Better  Mothers  Contest, 
the  distribution  of  two  million  pieces  of  educational  literature,  etc.,  were 
some  of  the  means  employed  to  arouse  popular  interest. 

The  Department  of  Health  was  but  one  of  many  public  and  semi- 
public  agencies  which  participated  in  this  campaign.  Important  aid  was 
rendered  by  the  Babies'  Welfare  Association,  the  Chamber  of  Commerce, 
the  Merchants'  Association,  the  Advertising  Men's  League,  the  New 
York  Milk  Committee  and  many  other  associations  and  committees. 

School  Medical  Inspection. 

The  school  registration  in  the  elementary,  public,  parochial  and 
high  schools  of  the  city  has  reached  912,583.  To  look  after  the 
health  of  these  children,  there  is  an  inspection  staff  under  the  direc- 
tion of  this  Department,  in  the  proportion  of  one  medical  inspector 
for  each   9,300  children,   and  one  nurse  for  each  4,700  children.     A 


15 

sharp  watch  is  kept  on  contagious  diseases,  and  that  this  has  been 
effective  is  demonstrated  by  the  fact  that  during  1914  it  was  unneces- 
sary to  close  any  school  building  in  the  city  on  account  of  contagious 
diseases. 

Efforts  to  Increase  the  Efficiency  of  School  Medical  Inspection. 

In  order  to  increase  the  efficiency  of  the  school  work  of  the  Depart- 
ment without  materially  increasing  the  working  force,  two  sets  of  experi- 
ments were  started.  In  the  first  an  effort  is  being  made  to  secure  the 
use  of  teachers  as  the  first  diagnostic  line;  in  other  words,  the  teach- 
ers have  been  instructed  in  the  methods  of  examination  for  minor  and 
major  contagious  diseases  as  well  as  in  the  detection  of  gross  physical 
defects  of  vision  and  hearing.  Children  who  are  selected  for  attention 
are  referred  immediately  to  the  nurse  or  the  school  inspector,  the 
latter  making  the  diagnosis  and  suggesting  the  appropriate  care. 

The  second  experiment  has  for  its  object  the  wider  use  of  private 
physicians,  without  expense  to  the  city,  in  the  work  of  physical  ex- 
amination. 

Employment  Certificates. 

Owing  to  the  new  child  labor  law,  which  now  requires  children  to 
pass  through  six  full  years  of  elementary  public  school  work  before  a 
school  record  can  be  issued,  thus  adding  a  year  and  a  half  to  the  former 
requirements,  there  was  a  marked  diminution  during  the  past  year  of 
the  number  of  children  to  whom  employment  certificates  were  refused 
because   of  insufficient   education. 

The  New  Policy  of  the  Sanitary  Bureau. 

In  the  Sanitary  Bureau  an  effort  has  been  made  to  replace  spora- 
dic inspections  based  upon  citizens'  complaints  by  systematic  inspec- 
tion work,  which  has  for  its  object  the  abatement  of  nuisance  by  the 
initiative  of  the  Department  itself.  Accordingly  a  house  and  block 
survey  of  the  entire  city  is  now  in  progress.  It  is  worthy  of  note 
that  during  1914,  18,863  complaints  of  nuisances  were  lodged  by 
inspectors  spontaneously,  as  against  32,571  made  by  citizens.  A 
continuance  of  the  present  plan  of  action  should  result  in  a  steady 
diminution  in  the  number  of  complaints  of  a  legitimate  character 
made  by  citizens. 

Survey  of  Lodging  Houses. 

Nearly  6,000  inspections  of  lodging  houses  were  made  during  the 
year,  and  these  led  to  the  issuance  of  600  notices  to  abate  nuisances.  An 
effort  was  made  to  encourage  cleanliness  on  the  part  of  lodgers.  At  the 
Municipal  Lodging  House  a  daily  bath  is  required.  In  other  lodging 
houses,  having  14,223  lodgers,  it  was  found  that  only  2,000  baths  were 
taken  daily. 

Common  Drinking  Cup  and  Common  Towel. 

Vigorous  efforts  were  made  in  theatres,  department  stores,  public 
institutions,  public  lavatories  and  wash  rooms  to  obtain  compliance  with 


16 

the  ordinance  which  forbids  the  use  of  common  drinking  cups  and  com- 
mon towels. 

Comfort  Stations   and  Railway  Toilets. 

An  effort  to  obtain  improvement  in  the  comfort  stations,  which  are 
maintained  by  the  transit  companies,  was  followed  by  decided  improve- 
ment, which,  however,  is  not  being  maintained.  The  Department  will 
continue  its   efforts  in  this   direction. 

Common  Horse  Troughs  Abolished. 

The  prevalence  of  glanders  necessitated  an  order  for  the  abolition 
of  common  horse  troughs  and  the  substitution  of  drinking  fountains  hav- 
ing a  system  of  water  supply  which  requires  the  use  of  individual  pails. 
The  Board  of  Aldermen  co-operated  in  this  work. 

River  Bathing  Restricted. 

The  increased  pollution  cf  river  and  harbor  waters  necessitated  the 

suppression    of    some   of    the   river   baths    as    a   measure   of   safety.  To 

replace  discontinued  river  baths,  the  municipality  is  urged  to   hasten  the 
construction   of  additional  interior  baths  and  pools. 

Roof  Tanks  Regularly  Inspected. 

Periodic  inspection  of  roof  tanks  was  inaugurated  by  the  Depart- 
ment in  1914.  In  consequence  of  the  conditions  revealed  in  the  course  of 
4,000  inspections  of  these  tanks,  it  became  necessary  to  issue  3,000  orders 
requiring  compliance  with  existing  regulations. 

Mosquito  Swamps  Drained  or  Oiled. 

Large  areas  of  salt  marsh  and  inland  swamps  in  the  Greater  City 
have  been  filled,  drained  or  oiled.  Wherever  the  ownership  of  property 
could  be  determined,  suitable  orders  and  notices  to  abate  mosquito- 
breeding  nuisances  were  issued. 

Improved  Conditions  at  Maspeth. 
At  Maspeth,  in  the  Borough  of  Queens,  a  shocking  condition  which 
had  existed  for  many  years  was  effectually  dealt  with.  Formerly  sewage 
direct  from  privies,  sinks,  wash  tubs,  and  cesspools  was  permitted  to 
flow  from  houses  into  the  street  gutter,  and  after  crossing  the  high  road 
to  find  its  way  into  Newtown  Creek.  Pending  the  construction  of  per- 
manent sewers  under  the  direction  of  the  proper  authorities,  this  long- 
standing nuisance  was  abated  by  securing  the  co-operation  of  the  resi- 
dents bordering  the  polluted  streets,  who  were  persuaded  to  install,  at 
their  own  expense,  temporary  drains  and  sewers. 

Conditions  at  Barren  Island. 
Court  proceedings  begun  against  the  corporations  operating  at  Barren 
Island  were  temporarily  suspended  during  the  latter  part  of  November, 
at  the  request  of  the  President  of  the  Board  of  Aldermen,  pending  inves- 
tigation and  report  by  an  expert  engineer  in  the  employ  of  the  Board  of 
Estimate  and  Apportionment. 


17 

Smoke  Nuisance. 

A  series  of  convictions  was  obtained  in  the  several  boroughs  for  vio- 
lation of  the  section  of  the  Sanitary  Code  relating  to  smoke  nuisance. 
One  case  against  the  New  York,  New  Haven  and  Hartford  Railroad 
resulted  in  a  fine  of  $500;  in  a  second  case  against  the  same  company 
sentence  was  suspended.  In  Brooklyn,  out  of  13  cases  taken  to  court, 
9  were  fined;  in  3  cases,  sentence  was  suspended,  and  in  one  case  the 
offender  was  imprisoned  in  jail  for  three  days.  Like  results  were  obtained 
in  the  other  boroughs. 

Chicken  Complaints  Diminished. 
In  ten  months  prior  to  November  1st,  1914,  4,702  complaints  were 
received  from  citizens  who  were  annoyed  by  sound,  smell  or  vermin 
from  neighbors'  chickens.  New  Department  regulations  were  then 
adopted,  and  during  November  and  December  only  263  complaints  of 
citizens   due  to  this  cause   were  received. 

The  Police  Squad  Handles  147,727  Items. 
Fifty  policemen   assigned  to   this    Department  by  the   Commissioner 
of  Police,  in  accordance  with  the  terms  of  the  Charter,  handled  147,727 
items  and  reported  upon  the  same;  they  arraigned  in  court  and  disposed 
of  4,263  cases. 

Co-operation  with  Police  Department  Extended. 

The  Department  was  fortunate  enough  to  obtain  the  sustained  co- 
operation of  the  Police  Department  in  the  enforcement  of  certain  sec- 
tions of  the  Sanitary  Code.  The  police  officers  assist  either  by  making 
arrests  for  obvious  violations  or  by  reporting  such  violations  to  this 
Department;  each  patrolman  on  his  regular  "beat!"  acts  as  an  auxiliary 
health  officer.     Valuable  aid  has  thus  been  rendered. 

Cleaner  Streets. 

Inspectors  and  field  workers  in  the  Sanitary  Bureau  have  been 
instructed  to  co-operate  with  the  Department  of  Street  Cleaning  in  pre- 
venting the  throwing  of  ashes,  garbage  and  other  refuse  into  the  streets. 

Clean-up  Week. 

The  annual  Clean-Up  campaign  was  conducted  in  record-breaking 
time.  It  commenced  at  a  conference  held  at  the  Department  of  Health 
on  April  29.  On  May  1,  $15,000  was  set  aside  for  special  clean-up  pur- 
poses for  the  use  of  the  Department  of  Street  Cleaning.  The  week  of 
May  11  to  17  was  devoted  to  an  energetic  campaign  of  publicity  and 
the  actual  removal  of  accumulated  rubbish  was  accomplished  from  May 
18  to  May  23. 

Altogether  1,750,000  circulars  of  information  were  distributed 
throughout  the  Boroughs  of  Manhattan,  The  Bronx  and  Brooklyn. 
Official  notices  of  the  date  of  removal  of  rubbish,  1,500,000  in  number, 
were  distributed  through  the  Police  Department  two  days  before  the 
actual  clean-up  began. 


18 

A  large  bill-posting  firm  posted  notices  calling  attention  to  clean-up 
week;  these  were  placed  on  all  the  wagons  of  the  Street  Cleaning  Depart- 
ment. Eight  hundred  mcving-picture  theatres  in  the  city  displayed  spe- 
cial slides  supplied  by  the  Department  of  Health,  announcing  "Clean-Up 
Week,"  and  the  newspapers  rendered  valuable  assistance. 

The  following  figures  represent  the  excess  loads  of  dirt  and  rubbish 
collected  during  Clean-Up  Week,  as  reported  by  the  Commissioner  of 
the  Department  of  Street  Cleaning: 

Manhattan.        The  Bronx.        Brooklyn.  Total. 

May  18 467  65       .  567  1,099 

May  19 451  74  805  1,330 

May  20 362  83  858  1,303 

May  21 359  80  670  1,109 

May  22 194  68  690  952 

May  23 28  92^  301  421^ 

Total   1,861  46214  3,891  6,214j4 

Contagious  Disease  Hospitals  for  Queens  and  The  Bronx. 

Early  in  the  year  the  Board  of  Estimate  and  Apportionment  author- 
ized the  construction  of  the  first  unit  of  a  new  hospital  for  contagious 
diseases  in  the  Borough  of  Queens.  The  contract  was  promptly  signed 
and  the  building  is  nearing  completion.  The  site  in  use  for  this  purpose 
zvas  purchased  by  the  city  more  than  eleven  years  ago. 

An  important  step  forward  was  made  when  the  Board  of  Estimate 
and  Apportionment  and  the  Board  of  Aldermen  sanctioned  the  purchase 
of  the  Seton  Falls  site  in  The  Bronx,  for  the  purpose  of  hospital  develop- 
ment. There  is  available  for  the  construction  of  this  hospital  the  sum 
of  $125,000.  Request  has  been  made  for  a  sufficient  sum,  in  addition, 
to  render  possible  the  construction  in  the  first  instance  of  a  group  of 
three  buildings,  the  completion  of  which  will  enable  the  Department 
to  discontinue  the  transfer  of  sick  children  to  North  Brother  Island — a 
practice  which  has  been  much  criticized. 

The  Future  of  North  Brother  Island. 
The  bulk  of  the  hospital  population  at  Riverside  Hospital,  North 
Brother  Island,  consists,  at  the  present  time,  of  adults  affected  with 
tuberculosis.  There  is  under  construction  on  the  Island  a  pavilion  for 
the  care  of  cases  of  venereal  diseases.  The  plan  of  the  Department  is  to 
devote  this  Island  in  the  future  wholly  to  the  care  of  adults  suffering 
from   tuberculosis  and  venereal  diseases. 

Following  Up  Hospital  Cases. 

During  the  year  a  system  of  follow-up  work  to  ascertain  the  after 
effects  of  contagious  diseases  upon  patients  discharged  from  the  hospitals 
of  the  Department  was  inaugurated. 

Whooping  Cough   Clinic. 
A  special  clinic  for  the  intensive  study  of  the  ciuse  and  treatment  of 
whooping  cough  has  been  established  at  the  corner  of   Avenue  C  and 


19 

16th  street,  in  the  vicinity  of  the  Willard  Parker  Hospital.  In  the  con- 
duct of  this  clinic  the  Bureau  of  Hospitals  and  the  Bureau  of  Labora- 
tories have  collaborated.  Early  reports  indicate  that  some  progress  has 
been  made  in  the  treatment  of  this  disease. 

New   Buildings. 

Construction  work  has  proceeded  steadily  throughout  the  year.  Five 
new  ward  buildings  were  completed,  two  at  Otisville,  one  at  Kingston 
Avenue  Hospital,  one  at  Willard  Parker  Hospital  and  one  at  Riverside 
Hospital. 

Charges  Against  Department  Hospitals  Refuted. 

Sensational  charges  having  been  made  that  children  treated  in  the 
hospitals  of  the  Department  of  Health  were  illegally  and  cruelly  inocu- 
lated at  these  hospitals  with  loathsome  diseases,  and  the  charge  having 
further  been  made  that  the  children  were  being  experimented  on,  and 
that  the  alleged  infections  were  the  result  of  such  experimentation,  the 
Department  investigated  the  published  allegations  and  on  February  27th, 
in  an  open  letter,  completely  refuted  the  charges  in  question. 

Clinical  Organization  Improved. 

A  model  form  of  medical  organization,  designed  to  meet  the  present 
and  future  needs  of  the  Department  in  its  hospitals  for  contagious  dis- 
eases, was  adopted  during  the  year.  Daily  attendance,  by  visiting  physi- 
cians, in  all  the  wards  of  the  hospitals,  is  now  the  rule. 

Post-Graduate  Work  in  Hospitals. 

A  society  for  clinical  study  has  been  organised  in  each  of  the  hos- 
pitals of  the  Department.  Each  member  of  the  staff  is  expected  to  devote 
himself,  during  his  spare  hours,  to  the  pursuit  of  some  special  topic  or 
branch  of  medicine,  and  is  granted  leave  of  absence  from  the  hospital 
during  stated  hours  each  week  for  the  practical  pursuit  of  the  special 
subject  assigned  to  him.  A  higher  grade  of  medical  service  is  expected 
to  be  the  result  of  this  post-graduate  work. 

Social  Betterment   of  Hospital  Nurses. 

With  the  object  of  affording  stimulation  to  the  nursing  staffs  of  the 
hospitals,  a  committee  has  been  formed  to  institute  lectures,  sources  of 
study,  forms  of  entertainment  and  tours  of  observation  for  the  nurses 
employed  in  the  several  hospitals  of  the  Department. 

Contagion  Among  Hospital  Employees  to  Be  Analyzed  and  Checked. 

The  Superintendent  of  Hospitals  now  reports,  month  by  month,  the 
number  of  contagious  disease  infections  occurring  among  the  physicians, 
visiting  physicians,  resident  physicians,  nurses  and  other  hospital  employees 
of  the  Department,  presumably  from  contact  with  hospital  cases.  Based 
upon  these  reports,  investigations  have  been  made  for  the  purpose  of 
lessening  the  dangers  of  contact  wherever  possible. 


20 

Hospital  Visits  by  the  New  York  City  Visiting  Committee. 

The  State  Charities  Aid  Association  was  invited  and  accepted  the 
invitation  to  make  periodic  inspections  of  the  hospitals  of  the  Depart- 
ment. This  work  has  been  done  by  members  of  the  Association's  New 
Y~ork  City  Visiting  Committee. 

Comprehensive  Plan  for  the  Development  of  the  Otisville  Sanatorium. 

A  committee  was  appointed  to  prepare  a  general  plan  for  the  layout 
of  the  Otisville  Sanatorium,  showing  the  grouping  of  future  buildings, 
service  roads,  paths  and  other  approaches,  disposition  of  lawns,  terraces, 
etc.,  and  the  general  location  of  plantations.  The  plan  which  has  been 
adopted  is  sufficiently  flexible  to  permit  of  minor  changes  from  time  to 
time  as  new  conditions  arise,  but  is  definite  enough  to  serve  as  a  prac- 
tical guide  in  the  location  of  future  buildings. 

Maintenance  Allowed  Employees  at  Otisville   Sanatorium. 

From  time  to  time  "maintenance"  has  been  allowed  to  various  em- 
ployees at  the  Otisville  Sanatorium.  The  practice  was  to  consider  each 
case  individually,  and  great  discrepancies  resulted.  A  study  has  been 
undertaken  which  has  for  its  object  the  standardization  of  "maintenance." 
In  this  pursuit  the  Department  has  the  aid  of  the  Bureau  of  Standards  of 
the  Board  of  Estimate  and  Apportionment. 

Departmental    Dietitian. 

Authority  was  obtained  for  the  employment  of  a  Departmental 
dietitian,  who  has  been  made  responsible  for  the  care,  character  and 
proper  distribution  of  food  supplies  in  the  hospitals  of  the  Department, 
and  for  educating  those  who,  have  charge  of  food  supplies,  in  habits  of 
economy  and  efficiency. 

Exemption  of  Alcohol  from  Taxation. 

Arrangements  were  made  for  obtaining,  without  payment  of  the 
Internal  Revenue  Tax,  the  Department's  supply  of  alcohol  for  its  hospitals 
and   clinics. 

A    New    System    of    Health    Administration    Experimentally 
Inaugurated. 

At  present  the  activities  of  the  Department  are  functionally  classified 
and  are  controlled  by  Bureau  Chiefs.  The  field  workers  of  the  Depart- 
ment are  directed  from  headquarters.  To  this  system,  advantageous  as 
it  is  in  many  ways,  there  are  three  principal  objections : 

1.  The  Director  of  a  bureau  is  too  far  removed  from  those  who 
do  the  field  work  of  the  bureau. 

2.  Where  there  is  a  high  degree  of  differentiation  of  function,  the 
individual  worker  ceases  to  see  things  in  their  true  proportion,  and  fails 
to  grasp  or  apply  the  broad  principles  by  which  the  Department  is  gov- 
erned. Mental  and  professional  development  are  inhibited  by  the  repeti- 
tion of  detail  work  of  a  monotonous  character. 


21 

3.  Various  bureaus  send  their  representatives  into  the  same  districts, 
often  into  the  same  houses,  which  results  in  undue  expenditure  of  time 
and  energy   and  in  annoyance   to  the  individual   citizen. 

Can  these  disadvantages  be  overcome?  How  far  can  the  work  of 
the  Department  be  improved  by  the  substitution  of  a  system  of  local 
or  district  administration  for  the  present  purely  functional  administra- 
tion? Can  field  workers  be  trained  to  perform,  and  can  they  actually 
perform  in  a  satisfactory  manner,  a  variety  of  functions? 

In  order  to  answer  these  questions  intelligently,  an  experimental 
health  district  has  been  established,  where  all  the  activities  of  the  Depart- 
ment are  locally  directed  by  a  single  district  chief,  who  represents  all  of 
the  bureaus  which  are  engaged  in  field  work.  That  there  is  much  promise 
in  this  experiment  is  shown  by  the  preliminary  reports.  For  example, 
during  the  last  week  of  the  year,  seven  agents  of  the  Department  made 
177  visits  in  99  houses. 

In  61  houses,  1  health  function  was  served. 

In  18  houses,  2  health  functions  were  served. 

In    8  houses,  3  health  functions  were  served. 

In    7  houses,  4  health  functions  were  served. 

In    1  house,    5  health  functions  were  served. 

In  4  houses,  6  health  functions  were  served. 
This  study  will  be  continued  during  the  coming  year,  and  with  the 
co-operation  of  heads  of  other  Departments,  may  even  be  carried  beyond 
the  strict  limits  of  our  own  work,  so  as  to  include  in  its  operation  the 
local  administration  of  all  of  the  health  and  related  activities  of  the 
municipality  within  the  experimental  district. 

Useless  Fumigation  Discontinued. 

Investigation  having  shown  that  fumigation  was  being  extensively 
practiced  by  the  Department  without  sufficient  evidence  to  warrant  the 
practice,  arrangements  have  been  made  to  reduce  the  Department's  fumi- 
gation activities  to  a  minimum.  The  present  program  is  discussed  fully 
in  the  report  of  the  Bureau  of  Infectious  Diseases. 

The  Reporting  of  Venereal  Diseases. 

The  number  of  cases  of  venereal  disease  reported  in  1914  was  approx- 
imately double  that  reported  in  the  previous  year;  this  shows  an  increased 
willingness  on  the  part  of  institutions  and  physicians  to  co-operate  with 
the  Department  in  its  efforts  to  gather  complete  statistics  of  these  diseases. 

Transmission  of  Disease  Through  the  Unnecessary  Overcrowding  of 

Passenger  Cars. 

After  pointing  out  the  readiness  with  which  certain  communicable 
diseases  are  transmitted  from  person  to  person  when  in  such  contact  as 
exists  between  passengers  in  overcrowded  public  conveyances,  the  Depart- 
ment sought  to  ascertain  whether  the  Public  Service  Commission  had 
seriously  endeavored  to  prevent  unnecessary  overcrowding.  A  public 
presentation  of   the   issue  was   made,   following   which   certain  members 


22 

of  the  Public  Service  Commission  manifested  a  lively  interest  in  the 
question.  At  the  time  of  this  writing,  the  matter  is  under  investigation 
by  the  Grand  Jury  of  Kings  County.  The  advisability  of  attempting  to 
regulate  transportation  from  a  public  health  standpoint,  by  means  of  a 
suitable  amendment  to  the  Sanitary  Code,  is  now  under  consideration. 

Handbook  of  Infectious  Diseases. 

The  handbook  of  the  Bureau  of  Infectious  Diseases  was  entirely 
rewritten.  This  manual  for  employees  serves  also  as  a  reference  book 
for  those  who  desire  to  make  an  intimate  study  of  the  functions  of  the 
Bureau  of  Infectious  Diseases. 

Numerous  monographs  and  circulars  in  regard  to  contagious  diseases 
were  issued  during  the  year. 

Investigation  to  Determine  the  Financial  Status  of  Patients. 

An  investigation  was  made  to  determine  whether  patients  entering 
the  hospitals  of  the  Department  could  pay  for  the  care  which  they  re- 
ceive.   It  was  found  that  very  few  could  do  so. 

Home  Supervision  of  Whooping  Cough. 

New  procedures  for  the  home  supervision  of  cases  of  whooping 
cough  reported  by  dispensaries  and  institutions  were  adopted  in  August. 

Investigation  of  Scarlet  Fever  Outbreaks. 

Two  outbreaks  of  scarlet  fever,  which  for  a  time  were  alarming, 
occurred  during  the  year,  one  at  Bayside,  L.  I.,  and  the  other  at  Staten 
Island.  Investigation  showed  that  in  both  instances  the  local  epidemics 
were  due  to  the  failure  of  parents  to  summon  physicians. 

Ambulance  and  Truck  Service  Reorganized. 

Three  new  motor  ambulances  were  purchased  and  put  in  operation, 
two  in  Brooklyn  and  one  in  The  Bronx.  The  ambulance  stable  and  dis- 
infecting plant  service  was  entirely  reorganized. 

New  Tuberculosis  Clinics. 

New  tuberculosis  clinics  were  opened  in  Flushing,  L.  I.,  and  in 
Parkville,  Brooklyn.  The  tuberculosis  clinics  in  Manhattan,  which  were 
formerly  conducted  by  the  New  York* Nose,  Throat  and  Lung  Hospital 
and  the  Good  Samaritan  Dispensary,  respectively,  were  taken  over  by  the 
Department  and  installed  in  new  quarters. 

Investigation    of   Tuberculosis    Clinics. 

At  the  request  of  the  Commissioner  of  Health  an  investigation  of 
the  tuberculosis  clinics  of  the  Department  was  made  by  the  Executive 
Secretary  of  the  Association  of  Tuberculosis  Clinics,  who  concluded  her 
report  with  the  recommendation  that  additional  nurses  be  employed. 
This,  however,  has  not  been  done. 


23 

Investigation  of  Discharged  Sanatorium  Cases. 

A  systematic  investigation  by  field  nurses  is  being  made  of  all  cases 
discharged  from  the  State  Sanatorium  at  Raybrook  and  from  the  Depart- 
ment of  Health  Sanatorium  at  Otisville,  the  object  being  to  ascertain  the 
final  results  of  treatment,  its  social  as  well  as  its  personal  value. 

Typhoid  Fever  at  Hart's  Island. 

In  consequence  of  an  outbreak  of  typhoid  fever  at  Hart's  Island  in 
August  and  September,  700  inmates  were  immunised  against  the  disease 
by  the  physicians  of  the  Department. 

Anti-Rabic  Clinics  Reorganized. 

The  anti-rabic  clinics  of  the  Department  were  reorganized  and  meth- 
ods made  uniform  in  all  boroughs.  A  new  clinic  was  opened  at  29  Third 
avenue,   Brooklyn. 

Foot  and  Mouth  Disease. 

Late  in  the  year  foot  and  mouth  disease  appeared  in  Long  Island 
and  all  the  cattle  in  a  number  of  stables  in  the  Borough  of  Queens  were 
destroyed  by  state  inspectors.  Two  suspected  cases  of  human  foot  and 
mouth  disease  zuere  observed.  A  general  order  was  issued  for  the  pas- 
teurization of  all  milk  during  the  continuance  of  the  epidemic. 

Diagnosis  of  Venereal  Diseases  Now  a  Municipal  Activity. 

The  special  fund  from  the  Bureau  of  Social  Research  which  has 
hitherto  been  used  for  the  support  of  diagnostic  laboratory  work  in 
venereal  diseases  was  exhausted  at  the  end  of  the  year.  Provision  having 
been  made  in  the  budget  for  1915,  this  work  will  be  carried  on  as  a 
municipal  activity. 

Examination  of  Applicants  for  Peddlers'  Licenses. 

In  co-operation  with  the  Bureau  of  Licenses,  a  clinic  for  the  exami- 
nation of  applicants  for  peddlers'  licenses  was  established  at  49  Lafayette 
street,  where  applicants  undergo  examinations  for  tuberculosis  and  other 
communicable  diseases. 

Care  of  Contagious  Diseases  in  Institutions. 

A  special  inspection  of  each  general  and  special  hospital,  home  for 
incurables,  orphan  asylum,  dispensary  and  similar  institution  in  the  city, 
was  undertaken  for  the  purpose  of  ascertaining  the  manner  in  which 
these  institutions  are  complying  with  the  Sanitary  Code,  which  requires 
that  in  every  public  hospital  and  dispensary  in  the  City  of  New  York 
there  shall  be  provided  and  maintained  a  suitable  room  or  rooms  for  the 
temporary  isolation  of  persons  suffering  from  infectious  diseases.  On 
the  basis  of  this  study,  suitable  regulations  were  adopted  for  the  care  oj 
contagious  diseases  in  all  public  and  semi-public  institutions  in  the  city. 


24 

Cases  of  Contagion  in  Out-of-Town  Institutions. 

The  Department  has  discontinued  the  practice  of  transferring  patients 

ill   with    contagious   diseases  from    out-of-town   institutions    to    the    city, 

on  the  principle  that  such  institutions,  in  justice  to  their  inmates,  should 

be  provided  with  suitable  facilities  for  the  isolation  of  contagious  diseases. 

Vaccination  of  Children  in  Parochial  Schools. 

The  State  Law  makes  compulsory  the  vaccination  of  children  attend- 
ing public  schools.  This  law  does  not  apply  to  the  parochial  schools, 
which  are  under  the  jurisdiction  of  the  Catholic  School  Board;  the  vacci- 
nation of  the  children  attending  parochial  schools  has  hitherto  been 
neglected.  The  great  danger  involved  in  this  neglect  was  pointed  out 
to  the  officials  of  the  Catholic  School  Board,  who  promptly  and  cordially 
offered  to  co-operate  with  the  Department.  During  the  summer,  there- 
fore, 69,354  children  attending  the  parochial  schools  in  the  five  boroughs 
were  vaccinated  against  smallpox. 

Control  of  Tuberculosis  in  Lodging  Houses. 

Managers  of  lodging  ho'uses  are  now  requested  to  notify  this  Depart- 
ment of  the  .removal  of  all  persons  ill  with  tuberculosis.  Lodging  house 
cases  furnish  one  of  the  most  difficult  problems  in  the  tuberculosis  work 
of  the  Department.  This  new  procedure  will  make  it  possible  to  keep 
them  under  closer  observation. 

Examination  of   School   Lunch   Employees. 
An   examination   of   attendants   and   student   helpers   engaged  in  the 
public  school  lunch  service  was  made,  with  especial  reference  to  tubercu- 
losis, syphilis,  diphtheria,  typhoid  and  other  infectious  diseases. 

Additional  Vaccination  Centres. 

Additional  vaccination  centres  were  established  without  cost  by  includ- 
ing all  milk  stations  and  children's  clinics  in  this  classification,  in  addi- 
tion to  public  schools. 

Tetanus  Antitoxin  for  the  European  Armies. 

From  the  surplus  product  of  the  laboratory,  tetanus  antitoxin 
sufficient  to  immunize  200,000  wounded  men  was  sent  abroad  for  dis- 
tribution among  nearly  all  of  the  armies  engaged  in  the  war.  For  of 
all  this  supply  payment  is  to  be  made  to  the  city  at  cost. 

Increased  Use  of  Smallpox  Vaccine. 

The  amount  of  smallpox  vaccine  prepared  and  distributed  during 
1914  show-ed  a  large  increase  over  that  of  previous  years,  due  to  the 
active  campaign  in  favor  of  general  vaccination,  carried  on  by  both  the 
New  York  City  and  State  Departments  of  Health. 

The  Use  of  Anti-Meningitis  Serum. 
The  report  on  meningitis  shows  that  202  cases  were  treated  during 
the  year   1914  as   against   131   during  the  previous  year;    170  intraspinal 
injections  of  anti-meningitis  serum  were  performed. 


25 

Pasteur  Treatment. 

Pasteur  anti-rabic  treatment  was  given  to  852  patients  during  1914 
as  against  975  during  the  previous  year. 

There  were  three  human  deaths  from  rabies  during  the  year. 

During  the  last  six  months  of  the  year,  42  persons  who  had  been 
bitten  by  cats  received  Pasteur  treatment.  Of  this  number  33  patients 
were  bitten  by  12  cats  that  were  proven  to  be  rabid  by  a  microscopical 
examination  of  their  brains.  This  indicates  clearly  that  stray  cats,  as 
•well  as  stray  dogs,  should  be  captured  and  destroyed. 

Consolidation   of   Department  Laboratories. 

The  laboratory  work  of  the  Department  has  hitherto  been  under 
divided  control.  The  Research  Laboratories,  so-called,  were  in  charge 
of  the  Director  of  Laboratories,  while  the  Diagnostic  Laboratories  were 
"nder  the  supervision  of  the  Director  of  the  Bureau  of  Infectious  Dis- 
eases. At  the  close  of  the  year  the  laboratories  were  consolidated,  and 
the  entire  laboratory  organization  placed  in  charge  of  the  Director  of 
Laboratories.     Certain  economies  will  result  from  this  consolidation. 

Critical  Studies  of  Laboratory  Work. 

At  the  request  of  the  Commissioner  of  Health,  critical  studies  of 
various  phases  of  the  technical  work  of  the  Bureau  of  Laboratories  were 
undertaken  independently  by  three  different  members  of  the  Advisory 
Council.  All  pronounced  the  work  performed  to  be  of  a  very  high 
quality.     Some  valuable  suggestions  were  adopted. 

Analysis  of  Drugs  for  the  Police  Department. 

Owing  to  the  very  large  number  of  samples  of  narcotic  drugs  sub- 
mitted for  analysis  by  the  Police  Department,  the  Board  was  obliged  to 
ask  to  be  relieved  of  this  work,  which  was  accordingly  transferred  to 
the  Standard  Testing  Laboratory,  to  which  chemists  were  assigned  for 
the  purpose  by  the  Board  of  Estimate  and  Apportionment. 

Standardization  of  Drugs  and  Chemicals. 

A  committee  of  Department  employees  has  been  appointed  to  pass 
on  specifications  for  drugs  and  chemicals  submitted  by  the  Board  of 
Standards  and  Supplies. 

Bacteriological  Examination  of  Milk. 

Arrangements  were  made  whereby  the  number  of  milk  samples  exam- 
ined bacteriologically  was  more  than  doubled.  This  was  accomplished 
without  any  increase  in  the  force  of  the  bacteriological  laboratory. 

Analytical  Work  for  the  Milk  Commission. 

For  years  part  of  the  bacteriological  work  of  the  New  York  County 
Milk  Commission  was  carried  on  in  the  laboratories  of  the  Department. 


26 

The  Corporation  Counsel,  who  was  consulted  in  regard  to  the  legality 
of  this  arrangement,  expressed  the  following  opinion : 

"The  provisions  of  the  law  do  not  require  the  City  of  New  York  to 
bear  any  part  of  the  expenses  connected  with  the  activities  of  the  Milk 
Commission,  or,  in  strictness,  warrant  the  arrangement  whereby  the  Milk 
Commission  makes  use  of  the  employees,  supplies  and  apparatus  of  the 
Department  of  Health." 

In  view  of  this  decision,  an  amicable  arrangement  with  the  Milk 
Commission  was  made  for  the  withdrawal  of  its  work  from  the  labora- 
tories of  the  Department. 

Efficiency   Studies  in   Co-operation   with   the   Commissioners   of 

Accounts. 

Through  the  assignment  of  a  representative  of  the  Commissioners 
of  Accounts  to  this  Department,  by  request,  several  fruitful  investiga- 
tions were  made,  among  which  are  the  following : 

(a)  It  was   discovered   that  in   a  number  of   instances   physicians  had 

obtained  laboratory  products  from  the  Department  ostensibly 
for  use  among  the  poor,  but  that  such  products  had  not  been 
used  for  the  purpose  indicated.  The  Department  was  advised 
that  the  evidence  obtained  would  not  warrant  legal  action. 
Twenty  physicians,  were,  however,  sharply  warned. 

Incidentally  this  investigation  showed  that  diphtheria  anti- 
toxin had  been  used  in  many  cases  which  had  not  been  reported 
to  the  Department  as  cases  of  diphtheria.  In  future,  systematic 
comparison  will  be  made  between  antitoxin  receipt  stubs  and 
the  records  of  the  Bureau  of  Infectious  Diseases,  in  order  to 
insure  promptness  and  accuracy  on  the  part  of  the  medical  pro- 
fession in  the  reporting  of  diphtheria. 

(b)  A  study  was  made  of  the   telephone  requirements   in  the  various 

offices  of  the  Department  in  the  Boroughs  of  Manhattan  and  The 
Bronx.     Some  saving  has  resulted. 

(c)  It  was  discovered  that  condemned   food  supplies  were  being  sur- 

reptitiously removed  from  the  offal  dock.  The  Police  Department 
was  asked  to  co-operate  with  this  Department  in  its  efforts  to 
prevent  this  practice. 

(d)  Comparative  studies  were  made  of  the  work  performed  by  physi- 

cians, nurses,  nurses'  assistants  and  cleaners  in  a  number  of  milk 
stations. 

(e)  The  use  of  motor  and  horse-drawn  vehicles  in  the  Department  was 

studied  and  facts  ascertained  which  will  be  of  assistance  to  the 
Department. 

(f)  A  report  was  made  upon  the  work  of  the  Supervisor  of  Buildings 

and  Grounds. 

(g)  A  study  was  made  of  the  work  of  all  of  the  employees  attached  to 

The  Bronx  Borough  office.  In  one  Bureau  a  top-heavy  organiza- 
tion was  revealed;  suitable  changes  followed. 


27 

Accounting  Methods  at  the  Otisville  Laboratories. 

At  the  request  of  the  Commissioner  of  Health,  a  study  of  the 
accounting  methods,  care  of  valuable  stock,  etc.,  at  the  branch  laboratory 
at  Otisville  was  made  by  the  Office  of  the  Commissioners  of  Accounts. 
Based  upon  this  investigation  were  recommendations  in  relation  to  account- 
ing methods,  etc.,  which  were  adopted. 

Sales  of  Laboratory  Products. 

In  view  of  the  frequency  of  requests  for  the  free  distribution  of 
laboratory  products  to  municipalities  and  hospitals  outside  of  the  City 
of  New  York  the  Department  has  adopted  the  policy  of  using  "all  its 
resources  for  the  protection  of  the  health  of  the  city,"  at  the  same  time 
declaring  its  willingness  "to  co-operate  with  other  municipalities  and 
states  in  special  emergencies."  It  has  been  ordered  also  that  "services 
performed  for  other  communities  shall  be  duly  compensated." 

Stenographic  Division  Organized. 

The  organization  of  a  stenographic  division  at  headquarters  into 
which  have  been  gathered  the  stenographers  and  typists,  heretofore  scat- 
tered throughout  the  various  bureau  offices,  is  one  of  the  most  notable 
of  a  series  of  measures  inaugurated  during  the  year  to  increase  the 
efficiency  of  the  Department. 

Office  Congestion  Avoided. 

An  agreement  was  made  with  the  Department  of  Education  whereby 
children  seeking  admission  into  the  public  schools  may  be  entered  tem- 
porarily on  the  rolls  pending  the  receipt  from  the  Department  of  Health 
of  a  certificate  of  birth  in  each  case.  This  has  had  the  effect  of  avoiding 
congestion  at  the  Health  Department  offices  in  the  city. 

Study  of  Pension  Problem. 

A  committee  of  employees  was  named  to  study  the  pension  problem 
and  to  submit  suggestions  to  the  Mayor's  Pension  Committee,  from  the 
standpoint  of  participants  of  the  pension  fund  of  the  Department  of 
Health.  The  preliminary  reports  show  that  on  the  present  basis  the  early 
exhaustion  of  the  pension  fund  is  inevitable. 

The  Use  of  Public  School  Telephones. 

Through  the  courtesy  of  the  Board  of  Education,  permission  was 
obtained  to  use,  for  any  official  business  connected  with  this  Department, 
the  telephones  which  are  now  being  installed  in  all  public  schools  of  the 
city.  Reports  concerning  cases  of  acute  contagion  found  in  school  or  in 
absentee  visit  are  now  telephoned  to  the  Borough  offices  and  to  the  in- 
spector on  the  day  found. 

Definition  of  Part-time  Service. 

Many  of  the  professional  workers  of  the  Department  long  have  been 
employed  oh  a  part-time  basis.    An  official  definition  of  part-time  service, 


28 

applicable  throughout  the  Department,    was,  however,   lacking.      Such   a 
definition  has  now  been  promulgated. 

The  Avoidance  of  Conflict  with  Otjier  Departments. 

During  the  year  a  careful  study  was  made  of  the  Sanitary  Code, 
of  the  regulations  of  the  Department,  and  of  all  forms  of  Board  orders 
which  prescribe  or  require  any  kind  of  alteration  to  buildings,  with  a  view 
to  establishing  perfect  consistency  between  the  regulations  of  the  Board 
of  Health  and  those  of  other  City  and  State  Departments.  As  a  result 
of  this  study  conflict  of  orders,  confusion,  and  unnecessary  expense  to 
citizens  will  be  avoided. 

Department  Employees  and  Private  Business. 

An  order  was  issued  forbidding  employees  of  the  Department  to 
enter  into  or  to  maintain  business  relations  with,  or  to  accept  any  fee  for 
the  performance  of  professional  services  for  any  milk  or  other  firm 
whose  activities  are  under  the  supervision  of  the  Department  of  Health. 

Division  of  Research  and  Efficiency. 

The  Chief  of  the  Division  of  Research  and  Efficiency  in  the 
Bureau  of  Child  Hygiene  was  detached  from  that  Bureau  and  assigned 
to  the  office  of  the  Commissioner,  where  his  services  will  be  utilized  for 
the  benefit  of  the  Department  as  a  whole. 

Per  Capita  Cost  of  Operating  Clinics  Reduced. 

The  high  per  capita  cost  of  operating  the  Department  clinics  for 
school  children  was  materially  reduced  by  arranging  for  surgical  opera- 
tions in  these  clinics  every  week  day  in  place  of  every  other  day. 

Co-operation  with  Private  Physicians. 

In  every  possible  way  efforts  have  been  made  to  lighten  the  burdens 
of  the  Department  and  incidentally  of  the  taxpayers,  by  transferring  to 
private  physicians  clinical  and  other  functions  which  such  physicians  are 
able  to  perform  without  danger  to  the  public  health.  A  notable  instance 
of  the  application  of  this  new  policy  is  acceptance  on  a  child's  admission 
to  school  of  the  certificate  of  a  private  physician  in  lieu  of  examination 
by  the  Department's  own  medical  inspectors. 

Office  Consolidation  Saves  Men  and  Money. 

Throughout  the  year  studies  of  the  various  activities  of  the  Depart- 
ment were  made,  with  a  view  to  the  more  effective  utilization  of  available 
means  and  forces.  In  consequence  of  these  studies,  a  number  of  unpro- 
ductive activities  were  discontinued.  By  means  of  office  consolidation  in 
the  Richmond  Borough  office,  several  valuable  employees,  who,  owing  to 
the  limited  amount  of  work  to  be  done  in  the  Richmond  Borough  office, 
were  little  more  than  supernumeraries  there,  were  transferred  to  branches 
of  the  service  where  their  help  was  badly  needed.  A  similar  study  of 
the  work  of  the  Queens  Borough  office  has  since  been  undertaken. 


29 

The  New  Board  of  Promotions. 

The  departmental  Board  of  Promotions,  which  previously  consisted 
of  three  individuals,  was  reorganized  early  in  the  year,  so  as  to  include  as 
members  of  the  Board  all  Bureau  chiefs. 

Uniform  Absence   Rules. 

A  uniform  method  of  dealing  with  requests  for  "leave  of  absence 
with  pay"  was  inaugurated. 

Bonding  of  Employees. 

Instructions  were  issued  to  protect  the  city  by  bonding  a  number  of 
Department  employees  who  handle  considerable  amounts  of  cash  money. 

Control   of  Appropriations   for   Supplies   Established. 

In  order  to  show  each  chief  of  Bureau  precisely  where  his  Bureau 
stands  in  the  matter  of  supplies,  and  whether  in  a  given  month  goods 
have  been  consumed  in  excess  of  the  available  appropriations  for  any 
particular  purpose,  a  form  was  inaugurated  for  monthly  distribution 
showing  the  following  facts : 

1.  Amount    of    annual    appropriation    for    supplies     (each    appropriation 

item  to  be  separately  stated). 

2.  Amount  of  monthly  appropriation  calculated  as  one-twelfth  of  annual 

appropriation. 

3.  Amount  of  requisitions,  item  by  item,   during  the  month  covered  by 

the  report. 

4.  Amount  available  for  the  period  since  the  beginning  of  the  fiscal  year 

(on  a  pro-rata  basis). 

5.  Amount  actually  used  since  the  beginning  of  the  fiscal  year. 

Substitution  of  Written  for  Oral  Orders. 

Inquiry  having  indicated  that  in  some  of  the  divisions  of  the  Depart- 
ment important  instructions  to  groups  of  workers  had  been  given  orally, 
in  so  informal  a  manner  that  it  would  be  impossible  to  prove  conclusively 
when  such  instructions  were  issued,  to  whom  issued  and  with  what 
emphasis,  heads  of  Bureaus  were  instructed  that  all  orders  which  are 
equivalent  to  rules  and  which  affect  groups  of  workers  should  invariably 
be  reduced  to  writing  and  formally  promulgated. 

Authority  Fixed  in  Cases  of  Absence. 

Bureau  heads  were  requested  to  designate  subordinate  officers  to  act 
as  chiefs  when  prompt  bureau  action  is  required  on  such  matters  as  may 
come  up  during  the  absence  of  the  titular  chief. 

Unit  Cost  of  Various  Functions  Ascertained. 

Statements  have  been  completed  showing  the  unit  cost  of  functions 
and  activities  of  the  Department;  these  figures  will  prove   of  value  to 


30 

the  Department.  Departments  of  Health  in  other  cities  will  be  urged 
to  follow  suit,  and  valuable  and  instructive  comparative  data  will,  it  is 
hoped,  thus  be  obtained. 

Printed  Codes  for  Field  Workers. 

Many  inspectors  and  other  field  workers  of  the  Department  were 
without  comprehensive  printed  codes  of  instructions.  Inspectors  were 
expected  to  carry  in  their  minds  many  of  the  instructions  given  them. 
Each  Bureau  chief  was  therefore  directed  to  formulate  a  code  of  in- 
structions applicable  to  the  field  workers  of  his  particular  Bureau. 

Prompt  Answers  to  Correspondence. 

It  was  ordered  that  "any  inquiry  addressed  to  the  Department  by  a 
citizen  should  be  answered,  or  at  least  tentatively  acknowledged,  on  the 
day  of  its  receipt,  that  such  acknowledgment  should  invariably  be  made 
within  twenty-four  hours,  and  that  all  communications  received  from 
outside  sources  by  the  Department  or  by  any  of  its  Bureaus  should 
receive  prompt  attention." 

Official   Representation   at   Conventions,   etc. 

In  order  to  meet  the  frequent  requests  from  Department  employees 
for  permission  to  attend  conventions  and  conferences  in  this  city  and 
elsewhere  in  the  Department's  time  and  at  the  expense  of  the  Depart- 
ment, a  committee  was  appointed  to  prepare  an  official  list  of  annual 
conventions  and  meetings  representation  at  which  is  clearly  desirable  in 
the  interest  of  the  Department. 

Acknowledgments. 

This  report  cannot  properly  be  concluded  without  an  expression  of 
gratitude  and  obligation  to  those  who  have  upheld  the  hands  of  the 
Department  during  what  has  been  perhaps  the  busiest  year  in  its  history. 

Many  of  the  procedures  of  the  Department  this  year  have  been  new. 
In  all  of  the  bureaus,  the  pace  has  been  quickened.  A  serious  effort  has 
been  made  to  hold  each  employee  of  the  Department  up  to  a  high  standard 
of  personal  achievement.  Officers  and  employees  have  been  asked  to  make 
sacrifices  to  which  they  have  not  been  accustomed.  In  some  instances 
salaries  have  been  reduced:  and  except  in  a  few  cases,  it  has  been  im- 
possible, owing  to  the  financial  stringency,  to  reward  zealous  and  efficient 
workers  according  to  their  merit.  Under  these  circumstances,  eagerness 
to  serve  the  Department  could  not  reasonably  have  been  anticipated. 
Nevertheless,  there  has  been  manifested  throughout  the  Department  a 
steadfast  devotion  to  duty,  and  in  many  instances  even  a  high  degree  of 
enthusiasm.  For  their  loyalty  to  the  best  traditions  of  the  Department, 
the  employees  as  a  body  merit  the  thanks  of  the  Board. 

The  Department  has  enjoyed  in  a  large  measure,  the  support  of  the 
press.  The  daily  press  of  the  City,  as  a  whole,  has  been  generally  fair 
and  often  generous  in  its  treatment  of  the  Department,  and  medical,  trade 
and  technical  papers  have  devoted  a  large  amount  of  space  to  the  discus- 


31 

sion  of  departmental  matters  of  special  interest  to  their  readers.  A  De- 
partment of  Health  cannot  satisfactorily  perform  its  educational  func- 
tions without  the  help  of  the  press;  and  it  is  fitting  that  this  help  should 
be  suitably  acknowledged.  Especially  is  the  Department  grateful  to  the 
following  publications : 

To  The  Globe  for  its  aid  in  the  pure  food  campaign,  and  for 
its  willingness  to   devote  extended  space  to  the  weekly  bulletins  in 
which  the  Department  has  endeavored  to  expound  the  Sanitary  Code; 
To  The  Tribune  for  its  exposure  of  fraudulent  medicinal  prep- 
arations ; 

To  The  World  for  its  articles  in  relation  to  the  Sanitary  Code, 
and  for  its  active  part  in  the  fight  for  subway  sanitation; 

To  The  American  and  The  Journal  for  a  series  of  illuminating 
articles  on  rabies; 

To  The  Evening  Post  for  its  generous  allotment  of  space  for  the 
subject  matter  of  the  Department's  bulletins: 

To  The  Times  for  its  Sunday  articles  treating  of  various  phases 
of  the  Department's  educational  program,  and  for  its  editorial  support 
and  sound  criticism ; 

To  The  Sun  for  its  helpfulness  in  the  vaccination  campaign  con- 
ducted by  the  Department  last  spring,  and  for  many  illuminating 
editorials  on  the  medical  policies  of  the  Department; 

To  The  Press  for  a  series  of  special  articles  in  its  Sunday  edition 
on  the  health  movement; 

To  The  Brooklyn  Eagle  for  bringing  home  to  the  citizens  of 
Brooklyn  the  essential  things  in  the  Department's  program; 

To  The  Standard  Union  for  enabling  the  Department  to  explain 
the  significance  of  anti-typhoid  inoculation; 

To  Harper's  Weekly  for  seconding  the  efforts  of  the  Department 
to  obtain  national  legislation  for  the  regulation  of  proprietary 
medicines ; 

To  The  Mail  for  its  interest  in  clean  milk  and  pasteurization; 
and  to  newspaper  writers  and  publishers  too  numerous  to  mention 
who  have  been  painstaking  in  their  efforts  to  promote  the  health  of 
the  city. 


Public  health  is  purchasable. 
Within  natural  limitations  a 
community  can  determine  its 
own  death  rate. 


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expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

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RECD 

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197 


Hear  Izrlz  (City)   Dept,    of  health 


5pvl 


